COVID-19 disease severity and associated factors among Ethiopian patients: A study of the millennium COVID-19 care center

Diabetes mellitus in sub-saharan Africa during the COVID-19 pandemic: A scoping review

BACKGROUND

The COVID-19 pandemic impacted the healthcare and outcomes of individuals with various chronic diseases. However, there is a paucity of data on the impact of the COVID-19 pandemic on diabetes mellitus (DM) in low-resource settings. To address this, we conducted a scoping review to explore the literature published on diabetes-related COVID-19 outcomes and care during the COVID-19 pandemic in countries of sub-Saharan Africa.

METHODS

We applied our search strategy to PubMed, Web of Science, CINAHL, African Index Medicus, Google Scholar, Cochrane Library, Scopus, Science Direct, ERIC and Embase to obtain relevant articles published from January 2020 to March 2023. Two independent reviewers were involved in screening the retrieved articles. Data from eligible articles were extracted from quantitative, qualitative and mixed-methods studies. Quantitative evidence was summarised using descriptive statistics, while a thematic framework was used to identify and categorise themes from qualitative evidence.

RESULTS

We found 42 of the retrieved 360 articles eligible, mainly from South Africa, Ethiopia and Ghana (73.4%). The incidence of DM among COVID-19 cases was 13.7/1,000 person-days observation. COVID-19 was associated with increased odds of death (OR 1.30-9.0, 95% CI), hospitalisation (OR 3.30-3.73: 95% CI), and severity (OR: 1.30-4.05, 95% CI) in persons with DM. Challenges in caring for DM during the pandemic were inadequate patient self-management, difficulties in healthcare access, and inadequate healthcare resources.

CONCLUSION

The COVID-19 pandemic was characterised by a high incidence of DM in persons infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high COVID-19-associated mortality, severity, and hospitalisation among people persons with DM. The pandemic also created difficulties in DM self-management and worsened the quality of DM care services. Policymakers should devise preventive and management strategies for DM during emerging and re-emerging infectious disease epidemics and outbreaks, given that such occurrences are increasingly frequent in the region.

Determinants of COVID-19 severity in Ethiopia: a multicentre case-control study

OBJECTIVE

It was necessary to understand the determinants of severe COVID-19 in order to deliver targeted healthcare services to prevent further complications and mortality. Identifying the factors associated with severe COVID-19 in Addis Ababa, Ethiopia, is the aim of this study.

DESIGN

A case-control study was conducted from October 2021 to March 2022.

SETTING

The study was conducted at three public COVID-19 treatment centres including Ekka Kotebe General, St. Peter Hospital and St. Paul's Hospital.

PARTICIPANTS

The study participants were COVID-19 patients admitted to three COVID-19 treatment centres. Cases were patients admitted with severe COVID-19, and controls were patients with mild or moderate COVID-19. A total of 306 patients (153 cases and 153 controls) selected by simple random sampling technique participated in this study.

OUTCOME MEASURES AND ANALYSIS

Data were collected by a face-to-face or telephone interviewer using a structured questionnaire. COVID-19 admission category, clinical and biomedical characteristics and comorbidity-related data were extracted from the participant's medical record. Multivariable binary logistic regression analysis was used to identify predictors of COVID-19 severity.

RESULTS

The odds of being old were 4.54 times higher among severe COVID-19 cases (adjusted odds ratio (AOR)=4.54, 95% CI=2.499 to 8.24), the odds of being male were 2.72 times higher among severe COVID-19 cases (AOR=2.72, 95% CI=1.46 to 5.057), being vaccinated for COVID-19 decreases the severity by 55.1% (AOR=0.449, 95% CI=0.251 to 0.801), having good knowledge about COVID-19 decreases by 65% (AOR=0.35%, 95% CI=0.195 to 0.63) among patients with severe COVID-19, the odds of being diabetic were 10.2 times higher among severe COVID-19 cases (AOR=10.2, 95% CI=4.596 to 22.61) and the odds of being hypertensive were 2.3 times higher among severe COVID-19 cases (AOR=2.26, 95% CI=1.092 to 4.685).

CONCLUSION

Male, older age, diabetes or hypertension comorbidity, COVID-19 vaccination and having inadequate knowledge about COVID-19 were determinant factors of severe COVID-19.

Regional and temporal variations in COVID-19 cases and deaths in Ethiopia: Lessons learned from the COVID-19 enhanced surveillance and response

BACKGROUND

The COVID-19 pandemic is one of the most devastating public health emergencies of international concern to have occurred in the past century. To ensure a safe, scalable, and sustainable response, it is imperative to understand the burden of disease, epidemiological trends, and responses to activities that have already been implemented. We aimed to analyze how COVID-19 tests, cases, and deaths varied by time and region in the general population and healthcare workers (HCWs) in Ethiopia.

METHODS

COVID-19 data were captured between October 01, 2021, and September 30, 2022, in 64 systematically selected health facilities throughout Ethiopia. The number of health facilities included in the study was proportionally allocated to the regional states of Ethiopia. Data were captured by standardized tools and formats. Analysis of COVID-19 testing performed, cases detected, and deaths registered by region and time was carried out.

RESULTS

We analyzed 215,024 individuals' data that were captured through COVID-19 surveillance in Ethiopia. Of the 215,024 total tests, 18,964 COVID-19 cases (8.8%, 95% CI: 8.7%- 9.0%) were identified and 534 (2.8%, 95% CI: 2.6%- 3.1%) were deceased. The positivity rate ranged from 1% in the Afar region to 15% in the Sidama region. Eight (1.2%, 95% CI: 0.4%- 2.0%) HCWs died out of 664 infected HCWs, of which 81.5% were from Addis Ababa. Three waves of outbreaks were detected during the analysis period, with the highest positivity rate of 35% during the Omicron period and the highest rate of ICU beds and mechanical ventilators (38%) occupied by COVID-19 patients during the Delta period.

CONCLUSIONS

The temporal and regional variations in COVID-19 cases and deaths in Ethiopia underscore the need for concerted efforts to address the disparities in the COVID-19 surveillance and response system. These lessons should be critically considered during the integration of the COVID-19 surveillance system into the routine surveillance system.

Prevalence of fever and its associated risk factors among patients hospitalised with coronavirus disease 2019 (COVID-19) at the Eastern Regional Hospital, Koforidua, Ghana

BACKGROUND

In Ghana, temperature check at various points of entry was adopted as a means of screening people for coronavirus disease 2019 without taking into consideration data on the local prevalence of fever associated with the disease. Our objective was to assess fever prevalence and its associated risk factors among patients hospitalised with coronavirus disease 2019 at the Eastern Regional Hospital, Koforidua in Ghana.

METHODS

We reviewed medical records of 301 coronavirus disease 2019 patients who were admitted at the Eastern Regional Hospital, Koforidua between May 5, 2020, and August 31, 2021. Data collected on a pre-designed extraction sheet was processed, entered and analysed using Microsoft excel 2019 and Stata/IC version 16.1 software. Prevalence of fever was estimated and a multivariable logistic regression model was fitted to establish risk factors associated with fever among hospitalised coronavirus disease 2019 patients. A relationship was accepted to be significant at 5% level of significance.

RESULTS

The prevalence of fever among hospitalised coronavirus disease 2019 patients was 21.6% (95% CI, 17.1%-26.7%). Risk factors associated with fever were age group [0-19 years (AOR, 5.75; 95% CI, 1.46-22.68; p = 0.013); 20-39 years (AOR, 3.22; 95% CI, 1.42-7.29; p = 0.005)], comorbidity (AOR, 2.18; 95% CI, 1.04-4.59; p = 0.040), and disease severity [moderate (AOR, 3.89; 95% CI, 1.44-10.49; p = 0.007); severe (AOR, 4.08; 95% CI, 1.36-12.21; p = 0.012); critical (AOR, 4.85; 95% CI, 1.03-22.85; p = 0.046)].

CONCLUSIONS

The prevalence of fever was low among hospitalised coronavirus disease 2019 patients at the Eastern Regional Hospital, Koforidua. However, there was an increasing risk of fever as the disease severity progresses. Fever screening may be utilised better in disease of higher severity; it should not be used alone especially in mild disease.

Compliance with COVID-19 preventive measures among chronic disease patients in Wolaita and Dawuro zones, Southern Ethiopia: A proportional odds model

Introduction

So far, shreds of evidence have shown that COVID-19 related hospitalization, serious outcomes, and mortality were high among individuals with chronic medical conditions. However, strict compliance with basic public health measures such as hand washing with soap, social distancing, and wearing masks has been recommended and proven effective in preventing transmission of the infection. Therefore, this study aimed to determine the level of compliance with COVID-19 preventive measures and identify its predictors among patients with common chronic diseases in public hospitals of Southern Ethiopia by applying the proportional odds model.

Methods

A facility-based cross-sectional study was employed in public hospitals of Southern Ethiopia between February and March 2021. Using a systematic random sampling technique, 419 patients with common chronic diseases were recruited. Data were collected using an Open Data Kit and then submitted to the online server. The proportional odds model was employed, and the level of significance was declared at a p-value of less than 0.05.

Results

This study revealed that 55.2% (95%CI: 50.4%-59.9%) of the study participants had low compliance levels with COVID-19 preventive measures. The final proportional odds model identified that perceived susceptibility (AOR: 0.91, 95%CI: 0.84, 0.97), cues to action (AOR: 0.89, 95%CI: 0.85, 0.94), having access to drinking water piped into the dwelling (AOR: 0.52, 95%CI: 0.32, 0.84), having no access to any internet (AOR: 0.62, 95%CI: 0.42, 0.92), having no functional refrigerator (AOR: 2.17, 95%CI: 1.26, 3.74), and having poor knowledge (AOR: 1.42, 95%CI: 1.02, 1.98) were the independent predictors of low compliance level with COVID-19 preventive measures.

Conclusion

In the study area, more than half of the participants had low compliance levels with COVID-19 preventive measures. Thus, the identified factors should be considered when designing, planning, and implementing new interventional strategies, so as to improve the participants’ compliance level.

Time from symptom onset to severe COVID-19 and risk factors among patients in Southern Ethiopia: a survival analysis

Objective

This study aimed to assess the time to severe coronavirus disease 2019 (COVID-19) and risk factors among confirmed COVID-19 cases in Southern Ethiopia.

Method

This two-center retrospective cohort study involved patients with confirmed COVID-19 from 1 October 2020 to 30 September 2021. Kaplan–Meier graphs and log-rank tests were used to determine the pattern of COVID-19 severity among categories of variables. Bivariable and multivariable Cox proportional regression models were used to identify the risk factors of severe COVID-19.

Results

Four hundred thirteen patients with COVID-19 with a mean age of 41.9 ± 15.3 years were involved in the study. There were 194 severe cases (46.9.1%), including 77 (39.6%) deaths. The median time from symptom onset to severe COVID-19 was 8 days (interquartile range: 7–12 days). The risk factors for severe COVID-19 were age >65 (adjusted hazard ratio [AHR] = 2.65, 95% confidence interval [95%CI]: 1.02, 3.72), cough (AHR = 1.59, 95%CI: 1.39, 2.84), chest pain (AHR = 1.47, 95%CI: 1.34, 2.66), headache (AHR = 2.04, 95%CI: 1.43, 2.88), comorbidity (AHR = 1.3, 95%CI: 1.01, 2.04), asthma (AHR = 1.6. 95%CI: 1.04, 2.24), and symptom onset to admission more than 5 days (AHR = 0.48, 95%CI: 0.34, 0.68).

Conclusion

Patients with symptoms and comorbidities should be closely monitored.

Survival Time to COVID-19 Severity and Its Predictors in South Gondar Zone, North-West Ethiopia: A Prospective Cohort Study

Background

Methods

Results

Conclusion and Recommendation

Factors associated with death in COVID-19 patients over 60 years of age at Kinshasa University Hospital, Democratic Republic of Congo (DRC)

Introduction

the objectives of the present study were to determine the mortality rate in patients over 60 years of age with COVID-19 and to identify risk factors.

Methods

the present historical cohort study took place at the Kinshasa University Hospital (KUH), DRC. Older patients admitted from March 2020 to May 2021 and diagnosed COVID-19 positive at the laboratory were selected. The relationship between clinical and biological risk factors, treatment, and in-hospital mortality was modeled using Cox regression.

Results

of two hundred and twenty-two patients at least 60 years old, 97 died, for a mortality rate of 43.69%. The median age was 70 years (64-74) with extremes of 60 to 88 years. Low oxygen saturation of < 90% (aHR 1.69; 95% CI [1.03-2.77]; p=0.038) was an independent predictor of mortality. The risk of death was reduced with corticosteroid use (aHR 0.54; 95% CI [0.40-0.75]; p=0.01) and anticoagulant treatment (aHR 0.53; 95% CI [0.38-0.73]; p=0.01).

Conclusion

mortality was high in seniors during COVID-19 and low oxygen saturation on admission was a risk factor for mortality. Corticosteroid therapy and anticoagulation were protective factors. These should be considered in management to reduce mortality.

Factors Associated for COVID19 Severity Among Patients Treated at Selgalu Treatment Center Assosa in Ethiopia: A Case-Control Study

Background

Most people infected with the SARS-CoV-2 virus experienced mild to moderate respiratory illness and recovered without requiring special treatment. However, some became seriously ill with conditions that require medical attention and intensive care unit (ICU) admission. Severity varies among individuals; this may be due to age differences and the presence of underlying disease conditions.

Objective

To identify factors associated with disease severity among COVID19 patients treated at Selgalu treatment center from November 1, 2020, to April 30, 2021.

Methods

A case–control study was implemented among patients admitted to Selgalu COVID19 treatment center in October 2021. A 210 (70 severe disease and 140 non-severe diseases), cases (disease severity), and controls (non-severe disease). Data entered to Epi data 4.6, exported to SPSS 25. A Chi-square test with a p-value of <0.05 was used as a statistically significant difference between characteristics of disease severity and non-severity of disease. Multivariable binary logistic regression was used to determine variables associated with disease severity based on an adjusted odds ratio with 95% CI and p-value < 0.05.

Results

210 (70 cases and 140 controls) selected charts in this study. Patients age category between 40–59 [AOR: 5.30 (2.27–12.34)], aged 60 or older [AOR: 3.85 (1.39–10.64)], patients with fever [AOR: 3.98 (1.59–9.96)], fatigue [AOR: 3.14 (1.50–6.54)], and hypertensive patients [AOR: 3.68 (1.53–8.82)] were significantly predictors for COVID19 disease severity after adjusting for other variables.

Conclusion

From this study, we conclude that being age 60 or older and 40–59 age groups, having symptoms of fever, fatigue, and underlying comorbid illness hypertension. Were identified a significant predictor of severe COVID-19 disease; despite our limitation of study data highlights the important factors associated with disease severity with covid19 admitted to Selgalu treatment center.